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Öğe The assessment of functional status in Turkish children with cerebral palsy (a preliminary study)(Wiley, 2005) Erkin, Gülten; Aybay, Canan; Kurt, Murat; Keleş, Işık; Çakçı, Aytul; Özel, SumruIntroduction: Cerebral palsy (CP) is one of the most common causes of disability in childhood leading to functional limitations. Assessment of the functional limitations is important to determine the severity of the disability in CP and to evaluate the benefit of the rehabilitation programme. However, the results of the measurements show variations according to different sociocultural characteristics. The Functional Independence Measure of Children (WeeFIM) had not been studied in Turkish children previously. The aims of this study were to evaluate the functional disability of Turkish children with CP by using WeeFIM and to compare the results with those of healthy counterparts. Methods: A total of 86 children aged 24 months to 120 months were included in the study. Forty-five children with CP and 41 healthy children representing the controls were evaluated with WeeFIM. Both children with CP and healthy controls were categorized into four groups according to their chronological age. The variations in the WeeFIM subsets scores (self-care, sphincter control, transfers and locomotion, communication and social cognition) and total WeeFIM scores in children with CP and healthy controls were analysed. Results: The children with CP had lower WeeFIM scores than healthy controls. The sphincter control subset scores of children with CP increased as they grew up. There was no statistically significant difference in all WeeFIM subset scores and the total WeeFIM scores among the four age groups of children with CP. Conclusion: The WeeFIM appears to be a useful instrument for measuring the disability of Turkish children with CP. However, studies with wider series are needed to generalize our results.Öğe Brucellar spondylodiscitis: a case report(Blackwell Publishing, 2006) Aydın, Gülten; Tosun, A.; Keleş, Işık; Ayaşlıoğlu, Ergin; Tosun, Özgür; Orkun, SevimBrucellosis is a common zoonosis which still remains as a major health problem in certain parts of the world. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylodiscitis is often difficult since the clinical presentation may be obscured by many other conditions. Herein, we reported an uncommon case of spondylodiscitis due to brucella in an elderly male who had diabetes mellitus and degenerative spinal disease as underlying conditions. The diagnosis was established by using magnetic resonance imaging after the brucella-agglutination test was found to be positive. The diagnosis was also confirmed by positive blood culture. A high degree of suspicion in the diagnosis of brucellar spondylitis is essential to reduce the delay for the treatment. Thus, it should be essentially included in the differential diagnosis of longstanding back pain particularly in regions where brucellosis is endemic. Screening serologic tests for brucella should be used more widely in cases with low index of suspicion, especially in endemic areas.Öğe Case report: Lipoma arborescens in childhood(2004) Aydin, Gülümser; Keleş, Işık; Karagülle Kendi, A.Tuba; Yilmaz L., Özlem; Orkun, SevimLipoma arborescens (LA) is a rare intraarticular lesion of unknown etiology, mostly described in adult patients. Unilateral knee joint is the most frequent site of involvement. LA may be associated with osteoarthritis in some patients. Magnetic resonance (MR) imaging findings are extremely characteristic in the diagnosis. We report herein a 15-year-old female patient with LA; who has atrial septal defect, and who presented with pain and swelling of bilateral knee joints. MR imaging showed characteristic signs of LA and mild osteoarthritis. In childhood patients with mono/oligoarticular effusion and synovial hypertrophy without systemic involvement; LA should be considered in differential diagnosis. MR imaging is a sensitive modality in the diagnosis of LA.Öğe Erkek sıçanlarda orşiektominin ve vitamin c desteğinin eritrosit deformabilitesi ve kemik mineral yoğunluğu üzerine etkilerinin incelenmesi(2012) Arslan, Mustafa; Çomu, Faruk Metin; Keleş, Işık; Arslan, AyşeAmaç: Erkek osteoporozu (OP) klinik tıpta önemli bir sorun olmakla birlikte kadın OP'sine kıyasla daha az ilgi görmüştür ve kemik kaybında rolü olan mekanizmalar hala netleşmiş değildir. Patofizyolojisinde oksidatif stresin rolü olduğu düşünülen birçok hastalıktan biri de OPdir. Bu çalışma orşiektomi uygulanmış sıçanlarda kemik mineral yoğunluğu (KMY), antioksidan enzim düzeyi, lipid peroksidasyonu ve eritrosit deformabilitesinde gelişebilecek olası değişiklikleri ve vitamin C desteğinin bu değişiklikler üzerine etkisini araştırmak amacıyla planlandı. Gereç ve Yöntem: Çalışmaya 20 adet erkek Wistar albino sıçan alındı. Sıçanlardan randomize şekilde kontrol (K, n6), uygulanan işleme göre orşiektomi (O, n7), ve orşiektomivitamin C (OVC, n7) olmak üzere 3 grup oluşturuldu. Oksidatif stresi değerlendirmek için kemik homojenatlarında, süperoksit dismutaz (SOD), malondialdehit (MDA) düzeyleri ölçüldü. Heparinize tam kan örneklerinden eritrosit paketleri hazırlandı ve gerekli işlemler sonrasında deformabilite ölçümleri gerçekleştirildi. Bulgular: Oksidan/antioksidan parametreler açısından gruplar kendi aralarında kıyaslandığında kemik dokuda: SOD aktivitesi O'grubunda OVC grubuna göre anlamlı düzeyde yüksekti (p0,032). Eritrosit deformabilite indeksi ise Grup Oda; K ve OVC grubuna kıyasla belirgin olarak yüksek bulundu (sırasıyla p0,003, p0,018).Sonuç: Çalışmada, orşiektomi sonrası eritrosit deformabilitesinde olumsuz değişikler gelişebileceği bunun da kan akımı ve doku perfüzyonunda işlevsel bozukluklara yol açarak kemik metabolizmasını negatif etkileyebileceği, vitamin C uygulamasının ise bu olumsuz etkiyi geri döndürebileceği sonucuna vardık. Yine de sonucun daha detaylı ve geniş serilerde yapılacak klinik ve deneysel çalışmalarla desteklenmesi ve detaylandırılması gerektiği kanaatindeyiz.Öğe Evaluation of Erythrocyte Deformability in Experimentally Induced Osteoporosis in Male Rats and the Effects of Vitamin C Supplementation on Erythrocyte Deformability and Bone Mineral Density(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2012) Arslan, Mustafa; Çomu, Faruk Metin; Keleş, Işık; Arslan, AyşeObjective: Male osteoporosis (OP) is a major problem in clinical medicine, but has gained less interest than female OP The mechanisms of male OP have not been explained well and are not clear yet. It is suggested that there is a role for oxidative stress in the pathophysiology of many diseases, one of them being OR In this study, we investigated the effect of orchiectomy on bone mineral density (BMD), the level of antioxidant enzymes, lipid peroxidation, and erythrocyte deformability in rats and the effect of vitamin C supplementation on the possible changes in these parameters. Metarials and Methods: A total of 20 male Wistar albino rats were randomized into three groups: controls (C, n=6), orchiectomized rats (O, n=7) and orchiectomized rats receiving vitamin C supplementation (OVC, n=7). The concentration of superoxide-dismutase (SOD) and malondialdehyde (MDA) in bone tissue homogenates were measured to assess the oxidative stress. Erythrocyte deformability was measured using erythrocyte suspensions at 5% hematocrit in phosphate buffered saline. Results: When oxidant/antioxidant parameters were compared between the groups, SOD activity in bone tissue was significantly higher in group 0 than in group OVC (p=0.032). Erythrocyte deformability was significantly higher in group O than in group C and OVC (p=0.003, p=0.018, respectively). Conclusion: Erythrocyte deformability may show negative variations, suggesting a causative role in disruption of blood flow and tissue perfusion, which also affect bone metabolism negatively Vitamin C supplementation seems to reverse those negative effects of variations in erythrocyte deformability. However, our preliminary results need to be confirmed in wider serious of experimental and clinical trials. Turk J Phys Med Rehab 2012;58:121-5.Öğe Factors affecting bone mineral density in men(Springer Heidelberg, 2009) Atalar, Ebru; Aydin, Gülümser; Keleş, Işık; İnal, Elem; Zog, Gulfer; Arslan, Ayşe; Orkun, SevimIn this study, in 131 men aged 20-75 years, we investigated correlations between bone mineral density (BMD) in the lumbar spine and femoral neck and endogenous factors (age, body mass index) as well as exogenous factors (calcium intake, physical activity, smoking, caffeine, socioeconomic and educational levels). The age had a negative effect on femoral neck BMD in patients overall, and on both lumbar spine and femoral neck BMD in patients under 50. Physical activity has effects on femoral neck BMD in men above 50. Lumbar vertebral BMD negatively correlated with smoking in patients overall, and this correlation persisted when patients aged 50 and older were analyzed separately. Femoral neck BMD was positively correlated with body mass index in men aged 50 and older. Given the variety of findings in the research literature regarding risk factors for low BMD, we suggest that genetic and geographic factors should be considered.Öğe Familial Mediterranean fever and ankylosing spondylitis in a patient with juvenile idiopathic arthritis: a case report and review of the literature(Springer Heidelberg, 2006) Keleş, Işık; Aydin, Gülümser; Tosun, Aliye; İnal, Elem; Keles, Hatice; Orkun, SevimThe association of familial Mediterranean fever (FMF) with juvenile idiopathic arthritis (JIA) or ankylosing spondylitis (AS), most commonly with negative HLA-B27 antigen, was described in several previous reports, although the pathogenic mechanism of this association still remains unknown. Herein we report an uncommon association of FMF with HLA-B27 positive AS as an occasional coincidence in a patient who had been diagnosed as having JIA 23 years previously.Öğe Kas-iskelet sistemi tutulumu olan brusellozisli hastalarda klinik ve laboratuvar özellikler(2005) Aydın, Gülümser; Keleş, Işık; Atalar, Ebru; Açıkgöz, Ergin Ayaşlıoğlu; Tosun, Aliye; Orkun, SevimAmaç: Kırıkkale ve kırsalında kas-iskelet sistemi tutulumu olan brusellozisli hastalarda demografik, klinik ve laboratuvar özellikleri incelemek. Gereç ve Yöntemler: Çalışmaya kas-iskelet sistemi tutulumu olan brusellozis tanısı konulmuş 28 hasta dahil edildi. Hastaların demografik özellikleri, yakınmasının süresi, şekli, olası enfeksiyon kaynağı sorgulandı. Ayrıntılı sistemik ve kas-iskelet sistemi muayene bulguları not edildi. Rutin biyokimya, tam kan sayımı, eritrosit sedimentasyon hızı, C-reaktif protein, romatoid faktör, antinükleer antikor, kan kültürü ve standart tüp aglütinasyon testleri yapıldı. Hastaların tümünde sakroiliak, lumbosakral ve gerekli görülen durumlarda periferik eklem radyografileri değerlendirildi. Klinik ve radyografik olarak derin eklemlerin tutulumundan şüphede kalındığı durumlarda magnetik rezonans görüntüleme yönteminden faydalanıldı. Bulgular: Hastaların yaş ortalaması 39.4 ± 14.4 yıl, hastalık süreleri 10.1 ± 12.7 aydı ve %64.3’ü erkekti. En sık izlenen semptom artralji (%85.7), bulgu ise splenomegaliydi (%32.1). Kan kültürü %39.3 hastada pozitifti. Eklem tutulumu olarak periferik artrit %71 oranı ile ilk sıradaydı ve en sık tutulan periferik eklemler %35 ile kalça ve dizdi. Sakroiliit %32 hastada tespit edildi ve %89’u unilateraldi. Spondilit %14 hastada ve en sık lomber segmentte (%75) izlendi. Her bir kas-iskelet sistemi tutulumunun tipi tüm parametreler açısından diğerleri ile kıyaslandığında sakroiliit grubunda sadece sakroiliak testleri pozitifliği, spondiliti olan grupta yaş, perküsyonla vertebra hassasiyeti ve spinal hareketlerle ağrının varlığı, diğerlerinden anlamlı düzeyde farklıydı (p< 0.05). Sonuç: Bölgemizde brusellozis saptanan ve aynı zamanda kas-iskelet sistemi tutulumu olan olgularda en sık tutulum periferik eklemlerde izlenmektedir. Sakroiliak ekleme yönelik özel testler sakroiliit için yol gösterici olabilir. Özellikle spinal hareketleri ağrılı ve perküsyonla hassasiyet saptanan brusellozisli yaşlı hastalarda omurga tutulumu olabileceği akılda tutulmalıdır. Spinal ya da periferik eklem ağrısı olan ve yumuşak doku romatizmasına bağlı şikayeti bulunan hastalarda brusellozis ayırıcı tanıda yer almalıdır.Öğe Plasma leptin concentrations in postmenopausal women with osteoporosis(Taylor & Francis Inc, 2005) Yılmazı, Murat; Keleş, Işık; Aydın, Gülümser; Orkun, Sevim; Bayram, Merih; Sevinç, F. Ceylan; Yetkin, İlhan; Üçler, KısaOsteoporosis is less common in obese individuals with increased bone mineral density (BMD) and plasma leptin concentrations. The aim of this study was to determine the correlation between leptin levels and BMD in postmenopausal women. The study consisted of 90 postmenopausal women with a mean age of 53.45 +/- 0.87 years who visited our outpatient clinic for the evaluation of BMD. Thirty-six postmenopausal women with osteoporosis (mean age: 54.52 +/- 1.41 years and mean body mass index (BMI, kg/m 2 ) 29.33 +/- 0.66), 30 age- and BMI-matched postmenopausal women with normal BMD, and 24 postmenopausal women (mean age: 52.79 +/- 1.48 years and mean BMI: 29.45 +/- 0.89) with osteopenic BMD were included in the study. Plasma concentrations of leptin after an overnight fast were measured by radioimmunoassay. BMD values were measured by dual-energy X-ray absorptiometry (DEXA) at the L 2 -L 4 lumbar spine and femoral neck. The median spine BMD value in the patient group (0.67 +/- 0.08 g/cm(2) , mean +/- SEM) was significantly lower than that in the control group (1.02 +/- 0.25 g/cm 2 , mean + SEM) and osteopenic group (0.87 +/- 0.05 g/cm 2 , mean + SEM) (p < 0.150). Plasma leptin concentrations were correlated with BMI in three groups (r(s) = 0.450, p = 0.025 in normal BMD group and r(s) = 0.4254, P = 0.009 in the osteoporotic group, and r(s) = 395, p = 0.015 in the osteopenia group. There was no correlation between plasma leptin concentrations and BMD values in three groups (r(s) = -0.89 in normal BMD group, r(s) = -0.124 in osteopenia group, and r(s) = -0.195 in osteoporosis group). From this study we conclude that circulating plasma leptin does not have a significant direct influence on bone mass in postmenopausal women.Öğe Predictive value of grip strength for bone mineral density in males: site specific or systemic?(Springer Heidelberg, 2006) Aydın, Gülümser; Atalar, Ebru; Keleş, Işık; Tosun, Aliye; Zog, Gülfer; Keleş, Hatice; Orkun, SevimThis study aimed to investigate the predictive role of grip strength on bone mineral density (BMD) of different sites in males. Two hundred thirty-four male patients were included in the study. BMD of lumbar spine, femoral neck, proximal radius-ulna (PRU) and distal radius-ulna (DRU) sites were measured by dual-energy X-ray absorptiometry and grip strength by using a hand dynamometer. Grip strength and BMD values of PRU and DRU at forearms were significantly higher on the dominant sides (P = 0.001, P = 0.001, P = 0.001, respectively). Stepwise linear regression analysis revealed that only the grip strength of the same side was the best predictor of the BMD of the dominant and non-dominant PRU with a ratio of 8.5 and 10.2%, respectively, whereas grip strength of the same side, age and weight were the best predictors of the BMD of the dominant and non-dominant DRU with a ratio of 25 and 24.6%, respectively. There was no predictive value of grip strength for BMD of lumbar spine and femoral neck. In conclusion, grip strength appears to be predictive of site specific rather than systemic BMD.Öğe Relationship between sexual dysfunction and psychiatric status in premenopausal women with fibromyalgia(Elsevier Science Inc, 2006) Aydın, Gülümser; Basar, M. Murad; Keleş, Işık; Ergun, Gülbahar; Orkun, Sevim; Batislam, ErtanObjectives. To evaluate the possible relationship between the sexual and psychiatric status of premenopausal female patients with fibromyalgia compared with healthy controls. Methods. A total of 48 female patients with fibromyalgia and 38 age-matched healthy controls were enrolled in the study. All the subjects were asked to complete the Female Sexual Function Index (FSFI) for sexual status and the State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) for psychiatric assessment. Serum biochemical analysis was done, and the serum hormonal levels were analyzed. Results. The mean BDI score for patients was significantly greater than the score for the controls (P 0.017) and the mean FSFI score was significantly lower than the score for the controls (P = 0.001). According to the FSFI data, female sexual dysfunction was found in 26 patients (54.2%) with fibromyalgia and only 6 controls (15.8%), a significant difference (Pearson chi-square = 14.46, P = 0.000). When the subscores of each domain of FSFI were evaluated, the most common sexual problem was diminished desire in patients (n = 30, 62.5%) and controls (n = 11, 28.9%). In the correlation analysis, the FSFI score showed a significant negative correlation with the BDI (r = -0.337, P = 0.002) and STAI (r = -0.413, P = 0.004) scores. No significant correlation was revealed between the FSFI and BDI or FSFI and STAI scores in the controls. Conclusions. Depression is one of the emotional disorders commonly encountered in women with fibromyalgia, most possibly leading to sexual dysfunction. Thus, sexual dysfunction related to impaired psychiatric status should be considered a common problem in premenopausal women with fibromyalgia.Öğe Romatoid artritli olgularda krikoaritenoid eklem değişikliklerinin klinik ve bilgisayarlı tomografi bulgularının karşılaştırılması(2002) Kara, Simay Altan; Bayar, Nuray; Keleş, Işık; Altınok, Deniz; Koç, Can; Orkun, SevimRomatoid artrit etyolojisi bilinmeyen, simetrik erozif atini ve multisistem tutulumuyla giden otoimmün bir hastalıktır. Krikoaritenoid eklemler romatoid artritten etkilenen gerçek diartroidal eklemlerdir. Çalışmamızda, romatoid artritli olgularda bu eklemlerdeki değişikliklerin semptom, fizik muayene ve bilgisayarlı tomografi bulguları karşılaştırıldı. Romatoid artrit tanıtı 15 olguda, 30 krikoaritenoid eklemin üstüste binme tekniği ile elde edilen bilgisayarlı tomografi görüntüleri incelendi. Sonuçlar, semptom ve fizik muayene bulgularıyla karşılaştırıldı. Krikoaritenoid eklemde %66.7 olguda semptom, %13.3 olguda fizik muayene, %80 olguda bilgisayarlı tomografi pozitifti. Krikoaritenoid eklem incelemesinde, kıkırdaklarda volüm (%30), dansite artışı (%30), sublüksasyon (%20), eklemde belirginleşme (%16.7) ve eklem mesafesinde daralma (%6.7) saptandı. Bilgisayarlı tomografi romatoid artritli olgularda klinik bulgu vermeyen krikoaritenoid eklem değişikliklerini göstererek olguların olası risklere karşı korunmasını sağlar. Eklem değişikliklerinin gösterilmesi ve takibinde kullanılabilecek başarılı bir görüntüleme yöntemidir.Öğe Two clinical problems in elderly men: Osteoporosis and erectile dysfunction(Taylor & Francis Inc, 2005) Keleş, Işık; Aydın, Gülümser; Orkun, S.; Basar, M. Murad; Batislam, E.Seventy-six of 108 random men aged 50 years or over were evaluated for erectile dysfunction with interviews of patients using the International Index of Erectile Function Form and minimal evaluation. Serum hormone concentrations were measured. Bone mineral density was measured using dual energy x-ray absorptiometry. Hormone levels did not show significance in terms of erectile dysfunction or bone mineral density results. Erectile dysfunction was determined in 57 (75%) of 76 palients. Ten (13.2%) patients had osteoporosis and 45 (59.2%) had osteopenia at the bone mineral density measurements. The distribution of bone mineral density groups relating to erectile dysfunction did not show significance. The frequencies of osteoporosis and erectile dysfunction increased with age, but the association of these conditions seems to be independent of each other and hormonal changes appear not to be the major determinants for both conditions in elderly men.
